Patterns of Outcome Measure Utilization in Stroke Rehabilitation Lower Extremity Trials Conducted in Low-to-Middle versus High-Income Countries

This review examined patterns of outcome measure (OM) utilization in randomized controlled trials (RCTs) of post-stroke lower extremity (LE) motor rehabilitation in low-to-middle income (LMICs) and high-income countries (HICs). Searches in MEDLINE, Embase, CINAHL and PsycINFO were conducted in accordance with PRISMA guidelines, up to December 2024. RCTs published in English that studied an adult population with stroke and examined an intervention for LE motor rehabilitation were included. A total of 1,548 RCTs were included. Compared to HICs, LMICs used more generalized impairment and activities of daily living OMs that rely on patient observation rather than direct patient participation (National Institutes of Health Stroke Scale, Modified Ashworth Scale Fugl-Meyer Assessment). In contrast, RCTs from HICs utilized a higher proportion of OMs which required active patient participation as well as more specific OMs focused on muscle strength (e.g., Motricity Index, Maximum Voluntary Isometric/Eccentric Contraction) and functional ambulation (e.g., 10-Metre Walk Test, 6-Minute Walk Test, and Biomechanical Gait Measures). This review underscores the differences between use of OMs in HICs and LMICs and the importance of consensus-based recommended OMs in future stroke motor rehabilitation RCTs trials which can be implemented across rehabilitation settings in both HICs and LMICs.